Posts filed under ‘Infecciones virales’

REVIEW – Human papillomavirus in 2019: An update on cervical cancer prevention and screening guidelines

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.173-178

ABSTRACT

The human papillomavirus (HPV) causes most cases of cervical cancer. Healthcare providers can help prevent this cancer by recommending HPV vaccination when appropriate, regularly screening women for cervical cancer, and following up on abnormal test results.

KEY POINTS

-Immunization against HPV can prevent up to 70% of HPV-related cervical cancer cases.

-Gardasil 9 is the only HPV vaccine currently available in the United States and is now approved for use in males and females between the ages of 9 and 45.

-In girls and boys younger than 15, a 2-dose schedule is recommended; patients ages 15 through 45 require 3 doses.

-Vaccine acceptance rates are highest when primary care providers announce that the vaccine is due rather than invite open-ended discussions.

-Regular cervical cancer screening is an important preventive tool and should be performed using the Papanicolaou (Pap) test, the high-risk HPV-only test, or the Pap-HPV cotest.

FULL TEXT

https://www.ccjm.org/content/86/3/173

PDF

https://www.ccjm.org/sites/default/files/additional-assets/PDFs/86_3_173.pdf

January 20, 2020 at 10:54 am

EDITORIAL – The return of measles—an unnecessary sequel

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.365-366

Concerns over fake news and alternative facts have permeated the fabric of our daily life. Trust in entrenched establishments seems to be at an all-time low. I grew up in the 1960s; I grew up with “don’t trust the man.” I grew up with the Vietnam War, Watergate, and the military-industrial complex, and I have read and heard enough since then to know that a good amount of our distrust was well founded. More recently, there has been increased public scrutiny of the “pharmaceutical-medical complex,” with concerns being raised in the media and by legislators regarding drug pricing, seemingly inappropriate physician prescribing of medications encouraged by drug manufacturers, and the overall costs of medical care. And yes, there is …

FULL TEXT

https://www.ccjm.org/content/86/6/365

PDF

https://www.ccjm.org/content/ccjom/86/6/365.full.pdf

January 20, 2020 at 10:52 am

Review – Measles: A dangerous vaccine-preventable disease returns

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.393-398

ABSTRACT

Although a safe and effective vaccine has been available for over 6 decades, vaccine hesitancy in the United States and social and political unrest globally have led to under-vaccination. As a result, in recent months, vaccine control of measles has been threatened with an alarming upswing in measles cases nationally and internationally. Here, we review the disease and its management in view of recent outbreaks.

KEY POINTS

-Measles is highly contagious and can have serious complications, including death.

-Measles vaccine is given in a 2-dose series. People who have received only 1 dose should receive either 1 or 2 more doses, depending on the situation, so that they are protected.

-The diagnosis of measles is straightforward when classic signs and symptoms are present—fever, cough, conjunctivitis, runny nose, and rash—especially after a known exposure or in the setting of outbreak. On the other hand, in partially vaccinated or immunosuppressed people, the illness presents atypically, and confirmation of diagnosis requires laboratory testing.

-Management is mostly supportive. Children—and probably also adults—should receive vitamin A.

-Since disease can be severe in the unvaccinated, immune globulin and vaccine are given to the normal host with an exposure and no history of vaccine or immunity.

FULL TEXT

https://www.ccjm.org/content/86/6/393

PDF

https://www.ccjm.org/sites/default/files/additional-assets/PDFs/86_6_393.pdf

January 20, 2020 at 10:50 am

2020-01 Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV 378 pag DHHS

Developed by the DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the Office of AIDS Research Advisory Council (OARAC)

What’s New in the Guidelines? (Last updated December 18, 2019 and last reviewed December 18, 2019)

* Antiretroviral Therapy to Prevent Sexual Transmission of HIV (Treatment as Prevention)

* Dolutegravir Recommendations for Individuals of Childbearing Potential

* Laboratory Testing for Initial Assessment and Monitoring of People with HIV Receiving Antiretroviral   Therapy

* Initiation of Antiretroviral Therapy

* What to Start

* Optimizing Antiretroviral Therapy in the Setting of Virologic Suppression

* Acute and Recent (Early) HIV Infection

* HIV and the Older Person

* Tuberculosis/HIV Coinfection

* Cost Considerations and Antiretroviral Therapy

* Table Updates

PDF

https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf

January 10, 2020 at 7:32 am

SARAMPION – NUEVAS RECOMENDACIONES DE VACUNACIÓN PARA SU CONTROL.

ALERTA EPIDEMIOLÓGICA – 02 de enero de 2020 – SE 1

BROTE DE SARAMPIÓN EN CURSO

NUEVAS RECOMENDACIONES DE VACUNACIÓN PARA SU CONTROL.

Ante la continua detección de nuevos casos de sarampión en la Ciudad Autónoma de Buenos Aires (CABA) y municipios del área metropolitana de la provincia de Buenos Aires asociado a proximidad de las vacaciones de verano y la alta movilidad poblacional hacia zonas turística, con el consiguiente riesgo de diseminación de casos de sarampión en otras jurisdicciones, el Ministerio de Salud de la Nación, en consenso con las jurisdicciones y las comisiones asesoras, recomienda continuar con las medidas de contención de brote en curso y decide actualizar las indicaciones de vacunación a viajeros hacia zonas con circulación viral activa…..

PDF

https://www.argentina.gob.ar/sites/default/files/alerta_31-12-19_version_final.pdf

January 4, 2020 at 7:47 am

A Liquid Biopsy Compatible Approach for Human Papillomavirus–Associated Oropharyngeal Cancer Detection

The Journal of Molecular Diagnostics January 2020 V.22 N.1 P.50-59    

Previous efforts to evaluate the detection of human papilloma viral (HPV) DNA in whole saliva as a diagnostic measure for HPV-associated oropharyngeal cancer (HPV-OPC) have not shown sufficient clinical performance.

We hypothesize that salivary exosomes are packaged with HPV-associated biomarkers, and efficient enrichment of salivary exosomes through isolation can enhance diagnostic and prognostic performance for HPV-OPC.

In this study, an acoustofluidic (the fusion of acoustics and microfluidics) platform was developed to perform size-based isolation of salivary exosomes.

These data showed that this platform is capable of consistently isolating exosomes from saliva samples, regardless of viscosity variation and collection method.

Compared with the current gold standard, differential centrifugation, droplet digital RT-PCR analysis showed that the average yield of salivary exosomal small RNA from the acoustofluidic platform is 15 times higher.

With this high-yield exosome isolation platform, we show that HPV16 DNA could be detected in isolated exosomes from the saliva of HPV-associated OPC patients at 80% concordance with tissues/biopsies positive for HPV16.

Overall, these data demonstrated that the acoustofluidic platform can achieve high-purity and high-yield salivary exosome isolation for downstream salivary exosome–based liquid biopsy applications.

Additionally, HPV16 DNA sequences in HPV-OPC patients are packaged in salivary exosomes and their isolation will enhance the detection of HPV16 DNA. . . . .

FULL TEXT

https://jmd.amjpathol.org/article/S1525-1578(19)30395-2/fulltext

PDF

https://jmd.amjpathol.org/article/S1525-1578(19)30395-2/pdf

January 3, 2020 at 3:50 pm

Baloxavir marboxil for uncomplicated influenza in adults and adolescents.

N Engl J Med 2018 Sep 6; 379:913.

Hayden FG et al.

BACKGROUND

Baloxavir marboxil is a selective inhibitor of influenza cap-dependent endonuclease. It has shown therapeutic activity in preclinical models of influenza A and B virus infections, including strains resistant to current antiviral agents.

METHODS

We conducted two randomized, double-blind, controlled trials involving otherwise healthy outpatients with acute uncomplicated influenza. After a dose-ranging (10 to 40 mg) placebo-controlled trial, we undertook a placebo- and oseltamivir-controlled trial of single, weight-based doses of baloxavir (40 or 80 mg) in patients 12 to 64 years of age during the 2016–2017 season. The dose of oseltamivir was 75 mg twice daily for 5 days. The primary efficacy end point was the time to alleviation of influenza symptoms in the intention-to-treat infected population.

RESULTS

In the phase 2 trial, the median time to alleviation of influenza symptoms was 23.4 to 28.2 hours shorter in the baloxavir groups than in the placebo group (P<0.05). In the phase 3 trial, the intention-to-treat infected population included 1064 patients; 84.8 to 88.1% of patients in each group had influenza A(H3N2) infection. The median time to alleviation of symptoms was 53.7 hours (95% confidence interval [CI], 49.5 to 58.5) with baloxavir, as compared with 80.2 hours (95% CI, 72.6 to 87.1) with placebo (P<0.001). The time to alleviation of symptoms was similar with baloxavir and oseltamivir. Baloxavir was associated with greater reductions in viral load 1 day after initiation of the regimen than placebo or oseltamivir. Adverse events were reported in 20.7% of baloxavir recipients, 24.6% of placebo recipients, and 24.8% of oseltamivir recipients. The emergence of polymerase acidic protein variants with I38T/M/F substitutions conferring reduced susceptibility to baloxavir occurred in 2.2% and 9.7% of baloxavir recipients in the phase 2 trial and phase 3 trial, respectively.

CONCLUSIONS

Single-dose baloxavir was without evident safety concerns, was superior to placebo in alleviating influenza symptoms, and was superior to both oseltamivir and placebo in reducing the viral load 1 day after initiation of the trial regimen in patients with uncomplicated influenza. Evidence for the development of decreased susceptibility to baloxavir after treatment was also observed. (Funded by Shionogi; JapicCTI number, 153090, and CAPSTONE-1 ClinicalTrials.gov number, NCT02954354. opens in new tab.)

FULL TEXT

https://www.nejm.org/doi/10.1056/NEJMoa1716197

 

FDA approves new drug to treat influenza [press release].

Silver Spring, MD: U.S. Food and Drug Administration; Oct 24, 2018. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm624226.htm

December 27, 2019 at 8:23 am

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